New medications target menstrual suppression for healthy women and girls
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“Menstruation is not a disease” say leading researchers

The recent approvals for extended use hormonal contraceptive medications that induce menstrual suppression in healthy women and girls, variously known as Lybrel (2007), Seasonale (2003) and Seasonique (2006) in the US, and Seasonale (2007) in Canada, have largely been greeted with uncritical praise in the mainstream media, and been given the stamp of approval by several leading professional medical organizations.

However, the Society for Menstrual Cycle Research has issued a much more cautious and critical position statement on the new “cycle-stopping” contraception. During their annual meeting (June 2007, Vancouver), leading researchers from the US and Canada discussed both the current consumer and medical interest in extended hormonal contraceptives to reduce or eliminate menstruation, and a general consensus emerged.

“It is the position of the Society that menstruation is not a disease,” says Christine Hitchcock, board member of the SMCR and Research Associate at the Centre for Menstrual Cycle and Ovulation Research, University of British Columbia; “Further research on the potential health risks and long-term safety of cycle-stopping contraception is still needed.”

In the four years since the last position statement from the SMCR on menstrual suppression more studies have become available on both endometrial safety and on patterns of unexpected and expected bleeding.

“Two reassuring one-year studies of endometrial safety following extended or continuous contraception use have found no abnormal changes,” Hitchcock notes. “But studies continue to exclude the experiences of normally cycling women (those who are not taking hormonal contraceptives). The Seasonale trials randomized women to standard or extended use; the Lybrel trials were observational and included no comparison group at all,” she adds.

What is also missing, according to the SMCR position statement, are long-term studies that address potential risks beyond the uterus, such as breast, bone and cardiovascular health. Furthermore, there is an urgent need for studies that address impacts on adolescent development, since young women and girls are a target audience for cycle-stopping contraceptives.

Hitchcock further states that “it is important to note that cycle-stopping contraceptives do not only reduce or eliminate menstrual bleeding, but also suppress the complex hormonal interplay of the menstrual cycle. The impacts of this cycle on women’s health are not completely understood. While we know quite a bit about oral contraceptive pills that are taken for three weeks at a time with a one-week break, we don’t know the long-term consequences of stretching out the duration of active pills or taking them non-stop for years at a time.”

And some women might not like the erratic bleeding that may accompany menstrual suppression. “The most recent studies on menstrual suppression demonstrate that unexpected bleeding that occurs during active pill-taking was common and dissatisfaction with bleeding patterns was the most common reason for discontinuation,” says Hitchcock.

Ingrid Johnston-Robledo, on the Board of Directors for SMCR and also a Professor in the Department of Psychology at the State University of New York notes that “it is also important that research address the social, psychological and cultural implications of menstrual suppression, as well as the biomedical effects.”

The SMCR remains concerned that pharmaceutical campaigns used to market cycle-stopping contraception depict the menstrual cycle as abnormal, undesirable, unnecessary and even unhealthy. “Messages that women's natural functions are defective or need to be medically controlled can lead to negative body image, especially in young women,” says Johnston-Robledo.

Arguments and advertisements for cycle-stopping contraception often describe debilitating menstrual cramps and heavy flow as reasons to suppress menstruation, but promote routine use by all women who would prefer not to menstruate for matters of convenience.

“While we recognize that cycle-stopping contraception may be useful for some medical conditions (such as severe endometriosis), we caution against its use as ‘a lifestyle choice’ [for women with otherwise healthy cycles] until safety is firmly established,” says Hitchcock.

Historically, nasty surprises with hormonal therapies for women (e.g., heart disease and hormone therapy for menopausal women, the link between oral contraceptives and blood clots, DES and various health problems) have taken many years to surface. Additionally, when any medication is evaluated for healthy women, the potential risks need to be weighed more heavily than in situations when medication is considered to treat a disease.

Some critics of the SMCR statement have claimed that women should be free to choose cycle-stopping contraception, but Hitchcock argues, “we firmly believe that authentic choice is only possible when accurate and comprehensive information is widely available.”